Roundtable Discussions

These 90-minute sessions encourage intimate discussions on different topics. Each table will have one speaker who acts as a facilitator and at least three, but not more than nine participants. Participants will register for one topic and are NOT PERMITTED to switch tables.

Educational Objectives:
1. Explain why certain data elements in non-gynecological reporting are critical to patient safety
2. Describe the proposed format for non-gynecological reporting of results
3. List 2 elements that have recently been proposed by the College of American Pathologists as additions to non-gynecological reporting
4. Discuss the advantages and disadvantages of report standardization for non-gynecological specimens

Unlike gynecological cytopathology reporting, non-gynecological cytopathology reporting has not been widely standardized. In an effort to improve report quality and communication among physicians, the College of American Pathologists Cytopathology Resource Committee recently proposed guidelines for uniform reporting of these specimens, incorporating existing regulations and best practices into the format. This roundtable discussion will introduce the concept of standardized non-GYN reporting as proposed by the CAP and familiarize pathologists and cytotechnologists with its requirements while allowing for open-forum discussions on the feasibility of implementation, advantages and disadvantages of this effort.

Cytotechnologists today are experiencing new challenges in the way they perform their duties. Traditionally, gynecologic cytology has been under close quality control; conversely, non-gynecologic cytology standards for cytotechnologists have not been set. For many cytology laboratories, gynecologic cytology volumes are decreasing while non-gynecologic cytology volumes and complexities are increasing. This change is causing cytotechnologists’ roles to evolve. Determining precise roles and proper evaluation techniques for cytotechnologists in non-gynecologic cytology practice are challenges facing many cytology laboratories. At the same time, laboratories are asked to do more with less. Administrative concerns arise with cytotechnologists spending more time on non-billable activities, such as FNA collections, and less time on billable ones, such as Pap smear screening. Cytotechnologists are being asked to expand their scope of duties to include ones that may need additional training. In the coming years, where will we go? In this session, we will discuss how we can develop measures to deliver quality services by cytotechnologists in this new age of increasing non-gynecologic demands.

Educational Objectives:
1. This session will provide guidelines by which the ACGME competencies can be met for both resident and fellowship training
2. The session will provide a venue for participants to discuss individual approaches to teaching in a variety of settings, focusing on particularly effective approaches to training

Training of both residents and fellows in cytopathology is challenging and varies greatly among institutions. Possible approaches to effectively teaching fundamental skills in diagnostic cytopathology are reviewed and discussed, including potential advantages and drawbacks of each method, based upon previous experiences in an academic setting. In addition, a thorough understanding and compliance with the ACGME competencies and requirements is critical for all training programs and program directors; such expectations will be discussed in detail to promote effective training and a successful site visit.

12:00 pm - 1:45 pm

Roundtable Discussion #4Credit Hours:1.75 CME/CMLEMaintenance of Certification: How Does It Affect Cytopathology? An Update from the American Board of PathologyDiane Davis Davey, MD

Educational Objectives:
1. Define components and requirements for maintenance of certification and recertification
2. Explain the role of the American Board of Medical Specialties, and describe why maintenance of certification may be necessary for all practitioners in the future
3. Summarize requirements for Parts 2 and 4 of MOC including self-assessment and practice performance and improvement
4. Describe current plans for the Part 3 modular examination and options to maintain both primary and subspecialty certifications
5. Identify sources of education and information regarding certification including web sites and professional societies

Maintenance of Certification (MOC) is required for all pathologists certified in 2006 or later. The original certificate is valid for 10 years if the pathologist participates successfully in MOC. All 24 member boards of the ABMS now have a MOC program. Individuals certified earlier with lifetime certificates are encouraged to participate in either MOC or voluntary recertification, although the original certificate will not be affected. The voluntary recertification program will end in 2013. MOC has 4 Parts: Part 1 is documentation of licensure and practice setting, Part 2 is lifelong learning and self-assessment, Part 3 is a secure examination, and Part 4 includes both peer attestations and practice performance and improvement programs. The Part 3 examination will be modular and provide a high degree of flexibility that can be tailored to practice setting. Pathologists have the option of maintaining certification in any or all areas in which they obtained a primary certificate.

It is important to be fair to our employees when administering disciplinary action. In order to do that, there needs to be an objective way to investigate what happened and assign it risk. Just Culture is a way to look at the error in an objective way, determining the who, how, what, where, and when of the error. Human error versus reckless behavior can be assessed and at-risk behavior can be examined. Based on the outcome of the findings, the employee will either be disciplined and remediated or the incident will be used as a learning experience.

Cytopathology as a science and clinical discipline is undergoing a rapid “evolution” in response to the current challenges in health care delivery, and the advances with new technology and disciplines, such as molecular testing, genomics, proteomics, digital imaging and communication technology. New informatics solutions are needed to turn the vast amount of data now becoming available into usable information. Pathology informatics is an important evolving sub-specialty of pathology involving the management and analysis of large complex sets of data derived from various tests performed in clinical and anatomic pathology laboratories. The goal of this roundtable discussion is to share with the participants the experience of the University of Pittsburgh Medical Center (UPMC) in utilizing pathology informatics in cytology training and education (conferences, publications, and web pages), research, marketing, automated screening, proficiency testing, consultation and telecytology, and QA practices.

Educational Objectives:
1. Participants will be able to evaluate the culture of their laboratory or practice setting and identify factors they can influence to improve the health of that culture
2. Participants will identify leadership traits and habits that can be developed to provide better outcomes in their practice setting
3. Participants will recognize factors that predispose failure under crisis settings as opposed to those that signal likely success

Management and leadership skills within health care organizations, and laboratories in particular, will be the focus of this session. Emphasis is particularly placed on those skills, choices and habits pertinent to the structure and culture of the organization that govern individual and collective behavior within them. Case scenarios will be used to illustrate healthy and disastrous responses to unexpected, stressful circumstances.

Educational Objectives:
1. Review of diagnostic classification of pulmonary neuroendocrine tumors
2. Delineate the diagnostic cytologic pitfalls of major categories of pulmonary neuroendocrine tumors
3. Discussion on the limitations of bronchial brushings and fine needle aspirations in providing diagnostic accuracy
4. Recognizing the importance of clinicopathologic correlation and use of ancillary techniques to improve diagnostic accuracy

Neuroendocrine tumors form a distinct group of lung neoplasms, sharing characteristic cyto-histologic, immunohistochemical, ultrastructural, and molecular features. This roundtable discussion will include review of the morphologic features of pulmonary neuroendocrine tumors, such as carcinoid tumors, atypical carcinoid tumors, small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma, with a special emphasis on morphology and cytologic features.